Endovascular treatment of ureteroarterial fistulas

Ureteroarterial fistulas (UAF) are very rare and less than 200 cases have been published since the first description by Moschowitz in 1908. Since 1978, with the introduction of ureteral stents an exponential increase of this condition has been reported. The predominant clinical symptom is massive, commonly intermittent or moderate hematuria. Untreated the mortality rate is 100%. Knowledge about this disease and a careful medical history are necessary prerequisites for correct diagnosis and successful treatment. The past medical history of patients with ureteroarterial fistulas shows several typical predisposing risk factors including previous pelvic or genitourinary surgery and chronic ureteral stents. Using selective angiography not only direct proof of the cause of bleeding can be found in the prevailing number of cases but also endovascular therapy possibilities can be revealed at the same time. In this article five patients with an ureteroarterial fistula, which could be successfully treated by stent graft implantation or coil embolization are described. The frighteningly high cumulative mortality of 67% before 1978 has been reduced to 17% since the introduction of endovascular treatment in 1996. Considering the more favorable results as well as the often limited life expectancy of the patients due to a malignant underlying disease, endovascular treatment should represent the therapy of first choice.